Sleeve gastrectomy with tailored 360° fundoplication according to Rossetti in patients affected by obesity and gastroesophageal reflux: a prospective observational study

Abstract

Background: Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed bariatric procedure. Recent studies demonstrated the correlation between LSG and gastroesophageal reflux disease (GERD).

Objectives: To evaluate the effectiveness of LSG + Rossetti antireflux fundoplication in patients affected by morbid obesity and GERD.

Setting: High-volume bariatric center, Italy.

Methods: This is a prospective, observational cohort study that enrolled 58 patients affected by obesity and GERD who underwent surgery. All the patients had a 12-month follow-up. Gastroscopies were performed preoperatively and at month 12 for 35 patients.

Results: At 1 year after surgery, patients had a consistent decrease in body mass index, from 41.9 ± 4.6 kg/m² to 28.2 ± 3.7 kg/m². GERD improved in 97.1% of patients. Co-morbidities, such as hypertension, type 2 diabetes, respiratory dysfunction, and arthropathies improved as well. The visual analogue scale score regarding the global state of health increased significantly, from 58.1 ± 17.1% before surgery to 98.8 ± 4.1% at 1 year after surgery. Two patients had a fundoplication perforation and needed reparative surgery (3.5%). One patient had anemia that needed a blood transfusion (1.7%). Complications were reduced with a learning curve.

Conclusion: LSG + Rossetti fundoplication was shown to be a safe and effective intervention. It could be considered an option in obese patients affected by GERD. A longer follow-up is needed to establish the long-term outcomes.

Keywords: GERD; Nissen fundoplication; Obesity; Quality of life; Rossetti fundoplication; Sleeve Gastrectomy.